The impact of the Covid-19 pandemic on the care of children with cancer in LMIC is of great concern, particularly on diagnosis and abandonment of treatment rates. Data supporting this concern however is limited to survey and anecdotal information. A retrospective with two cohorts design was used to compare new diagnosis and monthly abandonment rate in Java, Indonesia. We found that new diagnoses rates had dropped significantly during Indonesia’s first wave as compared to a pre-pandemic cohort [rate ratio 0.57, 95th (CI) 0.41-0.79)] and that as the first wave progressed, abandonment rates also rose in a statistically significant manner.

Cost effectiveness of support with out-of-pockets costs to prevent treatment abandonment in Malawi and sub-Saharan Africa; lessons learnt and the way forward – a report from CANCaRe Africa Junious Sichali1, Avi Denburg2, Harriet Khofi3, Cecilia Mdoka1, Deborah Nyirenda4, Yamikani Chimalizeni3, George Chagaluka3, Elizabeth Molyneux3, Marc Y. R. Henrion4,5, Sumit Gupta2, Trijn Israels11 Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), 2Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada,3 Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi, 4 Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi, 5Liverpool School of Tropical Medicine, Liverpool, UKCorresponding author:Dr Trijn Israels, CANCaRe Africa, Department of Paediatrics, Kamuzu University of Health Sciences (KuHES), Blantyre, Malawi. Email: cancareafrica@gmail.comWord count: 1189 wordsNumber of Tables: 0Number of Figures: 0Short running title: Cost-effectiveness of treatment abandonment preventionKey words: childhood cancer, treatment abandonment, cost-effectiveness,LMIC Low- and middle-income countryGICC Global Initiative for Childhood CancerCANCaRe Africa Collaborative African Network for Childhood Cancer Care and ResearchALL Acute lymphoblastic leukaemiaGDP Gross Domestic ProductDALY Disability Adjusted Life Year

Abstract Background: Location of cancer care (LOC: pediatric versus adult center) impacts outcomes in adolescents and young adults (AYA) with some cancer types. Data on impact of LOC on survival in AYA with osteogenic sarcoma (OGS) and Ewing sarcoma (EWS) are limited. Objectives: To compare differences in demographics, disease/treatment characteristics, and survival in a population-based cohort of AYA with OGS or EWS treated at pediatric versus adult centers Methods: The IMPACT Cohort captured demographic, disease, and treatment data for all AYA (15-21 years old) diagnosed with OGS and EWS in Ontario, Canada between 1992-2012. Patients were linked to provincial administrative healthcare databases. Outcomes were compared between patients treated in pediatric versus adult centers using appropriate statistical methods. Results: 137 AYA were diagnosed with OGS (LOC: 47 pediatric, 90 adult) and 84 with EWS (LOC: 38 pediatric, 46 adult). AYA treated at pediatric centers were more likely to be enrolled in a clinical trial (OGS 55% vs 1%, [p<0.001]; EWS 53% vs 2%, [p<0.001]) and received higher cumulative chemotherapy doses. Five-year event-free survival (EFS ± Standard Error) in OGS and EWS were 47% ± 4 and 43% ± 5, respectively. In multivariable analysis, the impact of LOC (pediatric vs adult center) on EFS in OGS (adjusted hazard ratio [HR] 1.15, 95% CI 0.58-2.27, P=0.69) and EWS (adjusted HR 1.82, 95% CI 0.97-3.43, P=0.06) were not statistically significant. Conclusion: Outcomes did not differ by LOC suggesting that AYA with bone tumors can be treated at either pediatric or adult centers.

Vaccination is a critical tool in the prevention of COVID-19 infection for individuals and for communities. The mRNA vaccines contain polyethylene glycol (PEG) as a stabilizer. Currently in North America only the BNT162b2 (Pfizer-BioNTech) mRNA vaccine is approved individuals 12 to 17 years of age. Most patients treated with contemporary regimens for acute lymphoblastic leukemia receive Peg-asparaginase and 10-30% will develop allergic reactions. Optimizing access and safety for vaccine administration for these patients critical. This report describes a process developed to support COVID vaccination in a cohort of adolescents and young adults with a history of PEG-asparaginase allergy.